Adrenal medullary transplant to the striatum of patients with advanced Parkinson's disease: 1-year motor and psychomotor data.
We studied motor and psychomotor changes over 1 year after surgery in 7 patients with severe idiopathic Parkinson's disease (PD) who underwent intrastriatal autologous adrenal medulla transplant. Significant clinical improvements were present 1 year after surgery and primarily involved increased quantity of "on" time and increased quality of "off" time: "on" time increased from a mean 60.7% of the waking day to 82.7%, and "off" function improved. In contrast, although "on" function also improved, statistically significant improvement occurred in only 1 measure, the Unified Parkinson's Disease Rating Scale activities of daily living subscale. Medications did not change, and motor fluctuations persisted. Improvement began several weeks after surgery, was maximal at 4 to 6 months, and was sustained thereafter. There was significant group improvement in quality of life measures of sleep and rest, social isolation, and ambulation. One patient had severe, recurrent depression postoperatively. The efficacy of adrenal transplant surgery is not transient, and specific functional improvements can be prolonged.
Goetz
C G
CG
Department of Neurological Sciences, Rush-Presbyterian St. Luke's Medical Center, Chicago, IL 60612.
Tanner
C M
CM
Penn
R D
RD
Stebbins
G T
GT
Gilley
D W
DW
Shannon
K M
KM
Klawans
H L
HL
Comella
C L
CL
Wilson
R S
RS
Witt
T
T
D000203:Activities of Daily Living; D000313:Adrenal Medulla / Q000637:transplantation*; D000704:Analysis of Variance; D003342:Corpus Striatum / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D011597:Psychomotor Performance; D011788:Quality of Life; D014182:Transplantation, Autologous